Provider Demographics
NPI:1316281058
Name:ARGUELLO, TYLER (PHD, LCSW, ACSW)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:ARGUELLO
Suffix:
Gender:M
Credentials:PHD, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 I ST
Mailing Address - Street 2:STE 303
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4311
Mailing Address - Country:US
Mailing Address - Phone:206-353-8607
Mailing Address - Fax:
Practice Address - Street 1:2210 BLUES ALY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3171
Practice Address - Country:US
Practice Address - Phone:206-353-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical